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Radiofrequency ablation of the heart as a method of treating tachyarrhythmias

In modern medicine, there is a trend towards the development and improvement of minimally invasive interventions in the human body. Increasingly, anesthesia and large incisions are being replaced by local anesthesia and several punctures. Such interventions are appreciated by patients with many different diseases whose treatment involves operations. Such methods include a surgical method for the treatment of arrhythmias - radiofrequency catheter ablation of the heart.

Content

The essence of the method of radiofrequency ablation

Radiofrequency ablation is a minimally invasive intervention for the treatment of arrhythmias, which are accompanied by a frequent pathological pulse (tachyarrhythmia).

Synonyms for radiofrequency ablation are: RFA, catheter destruction.

Normally, the pulse of a healthy person ranges from 60 to 90 beats per minute. The basis of the rhythmic contraction is the passage of an electrical signal through a special tissue of the heart muscle (myocardium) - the conducting system. Normally, the signal is formed in the main pacemaker - the sinus node. In the second node, the atrioventricular, it undergoes a delay for the synchronous contraction of the heart chambers, after which it reaches the heart muscle directly, causing the blood to flow into the vessels.

The considered path of the electrical signal forms a normal picture of the electrocardiogram. The reason for the formation of arrhythmias with a high pulse rate is the pathological passage of the pulse through the heart muscle. The purpose of the operation: through surgical intervention to make inactive certain anatomical areas of the conducting tissue of the heart.

The method is based on the effect on the heart tissue of the energy produced by the radio frequency generator. It has certain parameters of temperature, power and duration of exposure.

RFA

Arrangement of electrodes during RFA

Advantages and disadvantages of the method

The advantages of the method include:

  • lack of anesthesia and cuts;
  • targeted targeted exposure;
  • minimal complications from the normal pathways of the heart;
  • verification of the effectiveness of treatment during surgery;
  • quick recovery after surgery;

Disadvantages of intervention include:

  • stopping the arrival of radiofrequency energy to the focus of the arrhythmia during prolonged exposure, as a result of which it is necessary to repeat the procedure;
  • intervention for one arrhythmia does not prevent the appearance of its other types in the heart;
  • not all types of arrhythmias are amenable to surgical treatment by RFA;
  • with large heart sizes, the diagnosis of the location of the arrhythmic focus is complicated, and as a result, the percentage of successful treatment decreases;

There is a method for treating arrhythmias by exposing heart tissue to extremely low temperatures — cryoablation. It is preferable to conduct it in children, in places of proximity to normal and pathological pathways, large vessels. With cryoablation, the effect is less persistent and, as a consequence, the need for repeated procedures increases as compared with radiofrequency ablation.

Indications for

Atrial fibrillation (synonym for atrial fibrillation) is a popular indication for radiofrequency catheter destruction. This pathology is currently exclusively distributed among the population. The reason is a multitude of foci located in the left atrium at the confluence of large vessels - four pulmonary veins. As a result, the rhythm consists of irregular contractions of the heart.

Atrial fibrillation

Scheme of the development of atrial fibrillation

Also, an indication for catheter ablation is a congenital anomaly of the pathways - Wolff-Parkinson-White syndrome. The basis is the activity of the pathological pathway - the atrioventricular bundle. As a result, a modified ECG form appears. With the passage of an electrical signal along the normal and abnormal pathway, an arrhythmia is observed with a high heart rate, which can be fatal due to its transition to more dangerous types of rhythm disturbances.

Wolff-Parkinson-White syndrome

Scheme of the mechanism of development of tachycardia with Wolff-Parkinson-White syndrome

Very similar to the previous other type of arrhythmia - atrioventricular nodal tachycardia. It is characterized by the circulation of an electrical signal in two ways - normal and abnormal. However, both are part of the same anatomical formation - the atrioventricular node.

Atrioventricular nodal tachycardia

Scheme of the mechanism of development of atrioventricular nodal tachycardia

Atrial flutter is another important aspect of the indications for RFA. This type of arrhythmia is a closed circuit. Passing through it, the electrical signal forms on the ECG a picture of large waves (hence the name arrhythmia). RFA's goal is to make inactive the weak point of this chain.

Atrial flutter

ECG picture of atrial flutter

An important indication is ventricular premature beats. This term refers to an electrical signal that caused a contraction of the heart out of turn. The cause is the active electrical region of the heart tissue located in the ventricles of the heart (the main pumping elements). The number of such reductions per day is an important parameter for the decision to conduct RFA. The operation is applied when there are more than twenty thousand extrasystoles in the presence of a normal rhythm.

Arrhythmias of the heart and their causes - video

Contraindications

Contraindications include:

  • acute respiratory infections;
  • acute period of stroke and myocardial infarction;
  • exacerbation of chronic diseases;
  • abnormalities in laboratory parameters;

Preparing for surgery

Before the operation:

  • examination of the doctor with a detailed clarification of the details of the disease (beginning, stages of development, tried-and-true methods of treatment);
  • electrocardiography recording - the visual picture of the passage of an electrical signal through conductive paths, including archival films, is analyzed;
  • The daily recording of the electrocardiogram (Holter monitoring) is necessary for recording rhythm disturbances that appear at a specific time of day. In addition, it is necessary to calculate the number of ventricular extrasystoles;
  • if the ischemic nature of the arrhythmia is suspected, a study of the heart vessels is performed - coronarography;
  • research of the general analysis of blood, blood group and Rh factor;
  • a blood test for thyroid hormones is required before surgery for atrial fibrillation;

Methodology

Radiofrequency ablation is performed under local anesthesia (Lidocaine, Ultracain). For staging catheters (ablative and diagnostic), most often two punctures are used: under the left clavicle and in the right inguinal region. Further, under X-ray and electrocardiographic control, the search for the arrhythmia zone is carried out. After that, a point effect of radiofrequency energy on the myocardial tissue is made. In this case, the patient may feel pain and a burning sensation in the region of the heart, passing after the end of the exposure. The number of impacts per procedure for different types of arrhythmias varies from single to several dozen, depending on the area of ​​the anatomical zone. After checking the immediate effect of the intervention, the instruments are removed and aseptic dressings are applied.

RFA - schemes of operations

Rehabilitation and postoperative period

During the normal course of the operation, the patient returns to the ward after its completion. With access through the veins (vessels with low pressure) after a short period of time is allowed to lead a normal life. If an artery was used, then to prevent the formation of bruising until the morning, strict bed rest is observed, a pressure bandage is applied to this time. Further, electrocardiography, Holter ECG monitoring can be used to diagnose a remote effect of the operation. After that, in a conversation with a doctor, the need to take certain medicines, the timing of re-consultations and research is discussed.

Complications

Complications of this type of intervention include:

  • blood loss;
  • bruising at the puncture site;
  • allergic reaction to drugs for local anesthesia;
  • lung damage during puncture and accumulation of air inside the chest;
  • development of heart block (you may need to install a pacemaker);
  • recurrent arrhythmia;

This intervention due to the absence of anesthesia and incisions represents a minimal danger to the patient. Mortality is less than 1%.

Radiofrequency ablation of the heart: patient reviews

Ablation can only be treated positively, because in some diseases from the category of cardiac arrhythmias it is the only way to get rid of the disease once and for all. My son had ERW syndrome with frequent paroxysms up to 260 beats per minute, with loss of consciousness. I existed for 8 years with his illness, since life cannot be called life. Today I even shudder when I make a phone call from him, I even wonder if this will pass? Ablation completely freed us from this extra journey and from the nightmare. So with the testimony, of course, you need to do.

Candidate

http://forum.antivsd.ru/index.php?topic=16221.0

Made RFA 4 years ago. There were problems with the heart and the doctors said that they could not do without the RFA. Those problems that bothered, gone. But there were extrasystoles, and the IRR as it was, remained. RFA is not done with the IRR, but with heart rhythm disorders.

born to the USSR

http://forum.antivsd.ru/index.php?topic=16221.0

I did. The operation is not terrible. Yes, discomfort during the operation is present (as without it), but not so bright as to give it up. I had extrasystoles, before the operation it was 13%, after - 0.5%. I feel pretty good. Today you have an operation, you are in the hospital for 24 hours and go home.

Sweet Mila

http://forum.likar.info/topic/771861-radiochastotnaya-ablyatsiya/

They did two members of my family. In one case at once, and in the second there was a preliminary diagnosis. Launched an artificial attack electrode inserted through the nose into the stomach. Not deadly.

TaYak

http://forum.likar.info/topic/771861-radiochastotnaya-ablyatsiya/

RFA of the heart: the opinion of the cardiologist

Catheter ablation was introduced in the early 1980s and became the method of choice for the treatment of arrhythmias. She replaced many open heart surgeries in the treatment of several types of arrhythmias and has become a recognized alternative to drug therapy. In AV-nodal tachycardia, the efficiency of radiofrequency ablation approaches 100%, with Wolff-Parkinson-White syndrome, it is about 99%. With atrial flutter and ventricular premature beats, the effectiveness of the procedure is 85–90%. The lowest ablation efficiency, 60–80%, is observed during atrial fibrillation. In some cases, repeated procedures may be required to achieve a sustainable effect. Mortality during ablation is close to zero.

Guglin Edward Romanovich

http://www.consmed.ru/kardiolog/view/456588/

Radiofrequency ablation is an effective radical method for correcting many arrhythmias. The absence of anesthesia and operative trauma makes the procedure of surgery for the patient comfortable, and also ensures a quick return to normal life.

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